Writing with Scissors is the blog site of Howard Rodenberg, MD MPH, former Kansas State Health Director and columnist for the Journal of Emergency Medical Services (JEMS). He is a father, emergency physician, and slightly-past-fifty curmudgeon with great hair for his age. The "scissors" in question refer to those used by editors to weed out all things opinonated, controversial, or politically inappropriate...translated as "anything funny."

a new day
-
2016 is literally around the corner, leaving me with 18 months to
retirement. Its with a mixture of trepidation, expectation and hope that I
turn the page....

1 year ago

Wednesday, November 11, 2015

"Bags of Stuff": ACEP 2015

You may have heard about changes in the marketing
practices of pharmaceutical companies.
It’s now considered unethical for companies to offer, or for physicians to
accept, gifts from manufacturers of drugs and medical devices. The theory here, of course, is that physicians
who get stuff from these corporations are more prone to use those drugs or
devices regardless of efficacy or cost, driving up health care expenditures
without necessarily benefiting anyone but the purveyors of fine pills and
nostrums.

In all faith,
I cannot say that I’ve never been influenced by a drug company. I’ve written before in the pages about how,
on a small scale, I still know the dose of a currently obscure antibiotic
because during my internship a salesman for this drug brought my fellows and I
donuts every single day for a year. And
in the heyday of pharmaceutical marketing, when I had become an attending
physician in the early 1990’s, I went to Boston for a weekend on someone else’s to learn
about clotbuster therapy for heart attacks.
(Yes, the other person’s money was the company that made the drug.)

Personally, I miss those days. Not because I think I was corrupted by the
process, but because in an era where the practice of medicine and respect for
physicians has been knocked so far off it’s pedestal that we’re like the
shattered bust in the end credits of Peabody and Sherman, it would be nice to
be flattered once again. So yes, I’d
like to be influenced by the drug companies. I would happily take their money to
support research. I would beg to be one
of those players known as a “drug whore,” doctors who get shipped to meetings
both at home and abroad to present lectures on important topics such as Reversing
Anticoagulants and then get to say things like, “There are three agents out
there. I’m going to talk a lot about
one, very little about a second, and none about a third,” and then claim to be
an impartial evaluator of the literature.
Bring it on.

However, the simple fact is that emergency
physicians are relatively insulated from that sort of marketing. The reason is basic economics. We don’t do anything particularly profitable. With some rare exceptions, what we do is pretty
basic. We don’t use expensive antibiotics
or symptomatic medications, especially as much of our clientele couldn’t afford
them if we did. Because we have short clinical
attention spans, we don’t prescribe high-cost, long-term maintenance medications. Even most of the IV medications we use have
been around for long time, and while there are some medical devices we use they’re
rarely the innovative, costly, single-use, high-volume supplies used by our
colleagues. It’s not that we can’t use
them; it’s that we don’t need to in order to be the Great Triage Officer of
Life and Death. So there’s very little
money in pushing expensive blood pressure medications or coronary artery stents
to us. We simply just don’t use them.

That doesn't
mean we don't get "marketed."There are some pharmaceutical and medical
device companies who bring their wares to display. But it's mostly from
physician recruiters, individual physician groups looking to by pass the
recruiters' fees, and locums agencies trying to find part-time docs to go to
places that nobody can recruit for.There are risk management groups, billing
firms, places that outsource documentation, scheduling, and practice management.All of them say the same thing and use the
same words, most of which end in "-ize" (optimize, maximize,
incetivize), which is Latin for “make the galley slaves work.” So how do you stand out among the
competition?The answer, of course, is the trinket.

Here's my
disclaimer.Trinket acquisition is one of my primary drivers for
attending medical meetings.The education tends to be spotty unless you happen to
know a particular speaker is really good.I'm not a networker.Most of the receptions are way too
crowded, and most "open bars" really aren't.But I am totally enamored with the
scavenger hunt through the exhibit hall, to see what I can pick up and then
leave in a large tote bag for whatever housecleaner enters my hotel room after
I'm long gone.

Like any game,
however, you have to know the rules to play:

You may
take only take one of each item from any one exhibitor.

As long as
you don't have to talk, you may feign interest in anything.

If you are
required to talk, you may not lie.For
instance, you may not say you don't want to practice in dusty East Texas because you're
afraid the cat's allergies will start to act up.("But
it’s not like that! We have hills and trees! Watch our video!"
exclaims the lovely Miss Longview 2012.) You may, however, invoke fixed
personal characteristics as an excuse, as when dealing with recruiters for
hospitals in the oil-rich sheikdoms of the Middle East ("I'm not
sure my people do so well there.")

If you
don't know what something is, you have to ask so you can accurately record
it.

Record it, you say?But of course.Getting the stuff is only half the fun.Then you get to take it back to the hotel
to sort through it, and catalog in detail what you've obtained.(This is best done while eating room
service spaghetti and watching Los Reales in Game 1.)Then you compare it to your previous
catalogs to get a sense of how medicine has really changed.It's a faster, quicker, and much more
accurate way to look at medical progress than any old textbook or lecture.

With this as background, I'm pleased to report to you my gleanings from the 2015 Scientific Assembly of the American College of Emergency Physicians in Boston. Here we go:

Eight plastic
boxes of band-aid strips.Each box contains five band-aids.I have never really thought about how many
band-aids I use, so I don't know if this is enough for a week or a lifetime
supply.I have resolved to monitor my band-aid use
in the future as part of my own personal Customer-Focused and Culture-Changing
Continuing Quality Improvement project. (I've been looking for an excuse to
work all the hot administrative buzzwords into a sentence.Bingo.)

One golf
towel.I think it's a golf towel, because it has
a little grommet in it and some kind of clip. I don't play golf.But if I did, I'm not sure what message it
sends that I'm wiping grime onto your product's name.

One ice
scraper.This
is from some very nice recruiters for a hospital system in Southern Illinois. I actually suggested to the Cream Of
Collinsvile that if you're wanting people to move there, reminding folks that
they're going to have to chip snow and ice from their car may not be the best
pitch.In retrospect, though, I think maybe they
got it right, because the other selling point would be "We're really close
to East
St. Louis."

A full-size
selfie stick. Here’s the story. Last month the Dental Empress and I went on a
Mediterranean Cruise. As we wandered the
streets of the Old
World, we
learned that the Official Street Vendor Product of the European Union is the
selfie stick. So at lunch one day
outside the Colleseum we fell into a discussion with a British couple sitting
next to us and a Spansih foursome sitting one table over. The latter group had been drawn into
negotiations with a street vendor (who, I’m fairly certain, was not a native of
the TiberRiverValley) over the cost of a selfie stick. The initial asking price was ten euros. Then it went down to seven, at which point
the Brits noted that they had bought their selfie stick in Venice for only three
euros, in a fine example of free market economics. The final price was four euros, or a little
over five bucks, accounting for the difference in the cost of living between
the capital and provinces.

(The British couple, while great company
at lunch, were truly a mismatched pair.
He was a young, very quiet IT professional, while she was an older, extroverted
marketer and outdoors enthusiast. They
were describing how their first vacations together were disasters until they
hit on the solution to spend their holidays someplace where neither of them will
be particularly happy. Which is why they’ve
spent two weeks in each of the last three years at a hermetically sealed beach
resort in Egypt.
Which plan, as of this writing, probably needs to be rethought.)

Thirteen different sizes and shapes of
tote bags, of which I'm planning on keeping two.One is from Long Island Jewish Medical
Center.It's really of very high quality, with
zippers and a shoulder strap and quite subtle advertising for a give away item.It's also of sturdy fabric, which you
probably need while using the bag as a weapon to fight off the thugs which this
boy from Flyover Country is convinced lurks behind every corner of the New York
Tri-State Metropolitan Area.And yes, I cognitively know that at Long Island Jewish
Medical Center I'm more likely to encounter an elderly matron selling raffle
tickets for Hadassah, but they scare me, too.The other bag I'm keeping is an insulated
lunch bag forma healthcare management company, because helpingme carry my lunch is about the only thing
a healthcare management company will ever do for me.

Two
refrigerator magnets, one of which gives me the warning signs of atrial
fibrillation, which might be helpful on those days my heart skips a beat when I
find those forgotten "science experiments" in the back of my
refrigerator. The other says, "DammitJim, I'm a Doctor, Not a Data Entry Clerk,
" which is silly because everyone knows the Data Entry Clerk is Yeoman
Rand.

One round
plastic pizza cutter.

Six 2 GB flash
drives.

Four of those
things that you plug into your car's cigarette lighter, into which you then put
a USB cable, and then plug into your phone to charge it more slowly then you
burn power listening to Spotify.I don't actually know what they're
officially called.Car charger sounds wrong because you're not actually
charging your car, and you need some other pieces like a USB cord to charge
anything else.I do know you can usually find them in plastic buckets
for $3.99 near the check-out of the Quik Trip, which means they're probably
made in China for less then a nickel apiece, which lets me
know just how much those who peddle these promos think of me

Eleven
different sizes and shapes of bottles of hand sanitzer, all of which could pass
by the TSA as they are all less than three ounces in volume.

Four buttons
that say "I love night shifts;" a further button modeling the Flag of
Emergistan (a buzzard on a field of red, green, and blue); and a badge from a
company called Blue Jay Consulting that says "Be Happy" that I picked
up just so I could look at it and say, "Not so much.Go Royals."

("Emergistan," the Land of Emergency Room, is the creation of Edwin Leap, MD.He's an excellent writer, and has the gift for finding positives in the chaotic void.From a literary standpoint, he's the good
child you want to live next door, while I'm that distant relative you have to
invite for the holidays, and why you serve Thanksgiving dinnerat 10 AMso you can move him more quickly out of
the house.Catch up with Dr. Leap at edwinleap.com)

A plastic
slinky.

Ten plastic
foam squishy toys, incldung three ambulances, one gold key that won't fit
anything, three balls, a blue and gray fish, a yellow van with the VA logo, a
rhino., and a football.

Two
toothbrushes, one in a fold-up plastic travel case.One box of floss shaped like a tooth.A bicuspid, if you must know.

A rubber duck
with a stethoscope and that head thing that doctors are supposed to wear that
I've never actually seen a doctor wear.

A faux leather
mini football that seems tough enough for actual play.In contrasting this to the squishy
football, the good one is from a company in Texas.Which makes snese, because people in the
south take football seriously.The promotional football is not a toy.It's a lifestyle.

9 diferent
collapsible coozies, two of which are bottle-shaped.There was also one rigid cylinder shaped
coozie which was used to great effect as I put a brown glass bottle of cream
soda (yet another giveaway) inside it, totally covering up the label of the
latter and giving the impression that I was swilling my way through the exhibit
hall...an impression which, truth be told, I did nothing to correct.

16 different
computer screen wipes.Most are simply wispsof cloth, but one looks like a soft furry
green sea urhcin, or perhaps an inverted Scrubbing Bubble.

Seven
containers of chapstick.Four tubes, three plastic balls.

Three stuffed
animals. The two bears wearing promotional tee-shirts show great promise as dog
toys.The Snoopy dressed in World War I Flying
Ace gear is mine.

Eight plastic
sleeves that I couldn't figure out until it was explained to me that you're
supposed to stick them to the back of your cellphone so you can put your
driver's license and your credit card in there so you can keep them all
together and eliminate the need for a purse or wallet when you go out.it also means that when you loseyour phone, you can suffer identity theft
and have your credit ruined as well. I was also told that once you stick it on,
it's nearly impossible to get off. I can't use them myself, because I already
have an "I Was Brave" sticker featuring Thomas the Tank Engine on the
back of my phone from when I got my flu shot last year and didn't pass out.
(I've got a thing about needles.)

Seven small
notebooks, including one from a US-Saudi joint venture with Arabic script on
the cover which will go down beautifully with the TSA. Out of this assortemnt,
I'll be keeping a small red one that look like Chairman Mao's.I plan to paste fortune cookie papers into
it and quote them frequently in a cryptic yet knowing way.

One small
travel package of Kleenex.Why only one, you ask?Because there's no crying in ER.

Three letter
openers with covered blades, because death by an unsheathed letter opener is
just silly.

Seven
different lanyards with clips for ID badges, so you have seven different ways
to declare your corporate allegiance. (Disclaimer:My ID badge lanyard at work is form
Princess Cruises.)

Two large
plastic squeeze bottles, two medium-sized rigid plastic cups with built-in
straws, one travel cup, and one "shaker" from a vendor in Hawaii that
i was told is to be used to mix up protein shakes and the like, but that I will
keep becuase I thnk it would be somehow fitting to make tropical drinks for
sitting poolside in a cup sponsored by the Aloha State.

Six large
magnetic clips you put on your refrigerator to hang up your children's
drawings.Only one of them is big enough to use as a chip clip.My son is way past the refrigerator art
gallery stage of life.So you can guess which one I'm keeping.

Lots of candy.And lots of little plastic packages of
mints that I might maybe someday use as placebos. But when I do, I'll give them
a fancy name, like Obecalp.

A sewing kit,
which will prove to be of no use to me as I can sew a screaming kid, but cannot
fathom things like what buttons are or how they got there.

Eleven small
flashlight, presumably for looking at small things.

One tee-shirt
that says, "This is Your Brain on ICD-10."(Okay, you had to be there.)

Two yo-yos,
which may also be used as bolos to hunt small game in a survival setting.

One
collapsible travel cup.

Three
miniature harmonicas on key chains.

Two plastic
wishbones.

One squishy
blue rubber ring and one similarly textured clear rubber ball filled with lots
of smaller pink, green, blue, and yellow balls.Both of these blink incessantly when
squeezed.

One
retractable tape measure.

Two sets of
fake teeth that you can put between your lips.When you blow into a small mouthpiece, a
small fan creates a whirring sound.

Three gel
packs that I can freeze or heat as needed to provide pain relief when my
Dilaudid runs out.

Badge ribbons.If you've been to large meetings lately,
you will have noticed that the recent trend is for attendees to stratify
themselves through the ribbons they attach to their name badge, things that say
"Director" or "Board Member" or "Donor" and the
like.(I think these are the convention
equivalents of fifty-five year old men who drive fire-red sports cars, the
rainbow of markings on the amorous mandrill, and male peacock feathers.An evolutionary biologist would have a
field day sorting out this competition for status, not to mention the fertile
females.Or
maybe it's a more innocent behavior, sort of like a certain Labradoodle I know
named Goldie Goldstein who will fling her 70 pounds of dog at your head,
landing with a resounding thud , eyes open, mouth agape, tongue lolling,
drooling everywhere, as her saliva-punctuated way of proclaiming, "Pay
attention to me!").In response to this trend, there were several vendors
giving out additional ribbons with some less important mesages, including
"Troublemaker," "I Run With Scissors," "I Read Your
E-mail," and of course "My Ribbon is Better than Your Ribbon."I got a buch of those last ones.Two went on my badge so the fertile
females would look at me more than those one-ribbon guys.

A small lapel
pin of the Canadian flag.

A 3.7 ml
bottle of tabasco sauce, whch I look forward to using in its entirity on one
medium sized tiger shrimp.

116 assorted
pens, all fairly nondescript with the exception of one shaped like a femur and
another that haswobbly jack-in-the-box head with strands of blue yarn
hair on the top.84 write with black ink, the remainder blue.

A rubber
device that looks like a plastic pocket protector with an attachedmegaphone.What you do is slip this over the end of
your iPhone 5 and apparently an opening on the inside of the pocket is right
over the speaker, which then transmits the sound through the megaphone to the
world at large.Which is probably a great thing, if you have an iPhone 5
and have a background in cheerleading.The Dental Empress is a former cheerleader
(all four years, cheering football and basketball, not wrestling...I understand
that's important in Cheer World) so I know what a "Herky" is, and I'm
currently enamored with the "Cheerleader" by OMI but that's asclose as I get.Plus, I went right from an iPhone 4 to a 6
because the same cheerleader told me the 5 was awful, though in retrospect it
probably just needed a megaphone.And yes, on this one I had to ask.

That's just
the trinkets.I did actually look at some products as well.More on that later.Now, If only I could find a pen...